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HomeMy WebLinkAbout4/4/2002Meyer, N. ITY OF IOWA CITY, IOWA APPLICATION FOR AN ELECTRICIAN'S LICENSE Type of license for which you are applying: This application must be filled out completely and in detail and shall be on file with the Building Official. With $20.00. / 57] Journeyman [] Master's [] Restricted [] Maintenance CITY OF IOWA CITY RESIDENCE ADDRESS TELEPHONE NUMBERf~© ~'~"-~'~{ '~ ~ PRESENT EMPLOYER /~o,,..-]¥(jc~,~ ~_~'~'//, ~ ADDRESS OF EMPLOYER /~( ~ AGE ~ DATE OF BIRTH ~/~/~ BIRTHPLACE City STATE .~ ZIP SOCIAL SECURITY NO. State Have you ever had an electrical license revoked? And if so, give reasons: By whom? Have you previously been examined for an Electrical License by this Board? If so, state type and results of examination: Was it approved? Have you previous made an application for a City of Iowa City Electrical License? (over) ¢tlVIC. C. FNTI::R · 410 EAST WASHINGTON STREET · IOWA CITY, IOWA 52240 · (319) 356-5000 ELECTRICIAN'S LICENSE APPLICATION - CITY OF IOWA CITY Page ELECTRICAL EMPLOYMENT RECORDS (Give previous and present employers and complete address.) EMPLOYER DATES EMPLOYED: From Type of Electrical Work COMPLETE ADDRESS to EMPLOYER DATES EMPLOYED: From Type of Electrical Work .COMPLETE ADDRESS to EMPLOYER DATES EMPLOYED: From Type of Electrical Work COMPLETE ADDRESS to EMPLOYER DATES EMPLOYED: From Type of Electrical Work COMPLETE ADDRESS to I If this application is approved by the City, you will be notified as to when you will take your examination. The foregoing statements are true and correct to the best of my knowledge and belief. Signature of Applicant hisblg\electlic.apl~ Date